Measuring the Financial Impact of Oncology Nurse Navigation in a Community-Based Cancer Center

Background: Offering patients access to oncology navigation is not only recommended, it is also a requirement for certification of oncology programs endorsed by 2 national organizations.^1,2 However, the lack of reimbursement for the ONN (oncology nurse navigator), and difficulty measuring the benefits of navigation, lead many organizations to limit access to only larger patient populations (ie, breast, lung, and colon cancers). ^3-5 This community-based cancer center has a culture that strives to provide the highest level of care to all oncology patients. Therefore, a quality assurance project was proposed to identify if there is a financial benefit for oncology navigation. A pilot study to measure the financial impact of 1 tumor site ONN (head and neck cancer) was completed for fiscal year 2016. This study suggested the ONN (0.5 FTE) contributed $150,000 toward this facility’s contribution margin. A broader quality assurance study was initiated in 2017 after implementation of an oncology navigation software program.⁶

Objective: This quality assurance project seeks to measure the financial impact of 6 full-time ONNs, who navigate for multiple tumor sites.

Methods: The referral source of all new patients is noted in the ONN documentation (ie, physician, hospital staff, website, community calls self-referral, etc). A monthly report was generated to create 2 lists, extracting new self-referred patients from existing patients (ie, referrals from providers). Comparison and analysis of these 2 lists ascertained if any of the self-referred patients received hospital care and/or treatment services within 30 to 90 days after ONN care coordination. Financial analysis of any hospital services delivered to new self-referred patients determined if there was a financial gain or loss for each patient. This QA study uses annualized financial data extracted from 4/1/17 through 3/31/18.

Results: The ONNs (6) had contact with 2158 patients. Data extraction reveals that 25% of these patients were self-referred, and 11% of these patients were new to the organization (ie, no prior care). Financial analysis identified 216 new patients established care services after contact with the ONN. Final examination identified the contribution margin realized from ONN care coordination for this patient group was $950,000.

Conclusion: These financial data confirm the conclusions identified in the 2016 pilot study. If one uses a salary survey describing the median salary for an ONN is $74,000 to $135,000,⁷ this study suggests financial gains realized from ONN care coordination more than covers the cost for an ONN. This study is also limited, as it does not measure or fully identify the impact of ONN on quality indexes (ie, patient satisfaction, improved access to care, physician satisfaction).

References

1. Center for Medicare & Medicaid Services. Oncology Care Model. https://innovation.cms.gov/initiatives/oncology-care. Accessed July 1, 2018.
2. American College of Surgeons. Commission on Cancer. Standard 3.1 Patient Navigation Process. Cancer Program Standards: Ensuring Patient-Centered Care. https://www.facs.org/quality-programs/cancer/coc/standards. 2016.
3. Johnston D, Strusowski T. Barriers to administrative engagement in navigation programs. Journal of Oncology Navigation & Survivorship. 2018;9(3):112-119.
4. Wagner EH, Ludman EJ, Aiello Bowles EJ, et al. Nurse navigators in early cancer care: a randomized, controlled trial. J Clin Oncol. 2014;32:12-18.
5. Zangerle CM. Nurses as navigators. Nurs Manage. 2015;46:27-28.
6. OncoNav. Nurse Navigation Software. www.onco-nav.com/products/nurse-navigation-software. August 14, 2018.
7. Indeed. Nurse Navigator Salaries in the United States. www.indeed.com/salaries/Nurse-Navigator-Salaries. Accessed June 13, 2018.